Leopold’s Maneuvers are a systematic method of observation and palpation to determine fetal position, presentation, lie and attitude. It is preferably performed after 24 weeks gestation when fetal outline can be palpated
Keen observation of abdomen should give data about:
1. longest diameter in appearance (longest diameter (axis) is the length of the fetus)
2. location of apparent fetal movement (the location of the activity most likely reflects the position of the feet)
PREPARATION
(1) CARDINAL RULE: Instruct woman to empty bladder first. This will promotes comfort and allows for more productive palpation because fetal contour will not be obscured by a distended bladder
(2) Place woman in dorsal recumbent position, supine with knee flexed to relax abdominal muscles. Place a small pillow under the head for comfort
(3) Drape properly to maintain privacy
(4) Explain procedures to gain patient’s cooperation
(5) Warm hands first by rubbing them together before placing them over the woman’s abdomen to aid comfort. Cold hands may stimulate uterine contractions
(6) Use the palm for palpation not fingers
(7) During the first three maneuvers, stand facing the patients. For the last maneuver, stand facing patient’s feet
THE FOUR MANEUVERS
• FIRST MANEUVER: Fundal Grip: What fetal pole or part occupies the fundus?
-palpation of the fundal area to determine which fetal part is located in the uterine fundus
-to determine the presenting part or presentation (part of the fetus lying over the inlet)
PROCEDURES
(1) Nurse stands at the side of the bed, facing the client
(2) Using both hands, feel for the fetal par lying in the fundus
FINDINGS
-The nurse-midwife should ascertain what is lying at the fundus by feeling the upper abdomen (fundus) with tips of both hands. Generally, she will find there is a mass, which will either be the head or the buttocks (breech) of he fetus. The nurse-midwife must decide which pole of the fetus; it is by observing three points:
1. Relative consistency- the head is harder/ firmer than the breech
2. Shape- if the head, it will be round and hard, and the transverse groove of the neck may be felt. The breech has no groove and usually feels more angular
3. Mobility- the head will move independently of the trunk; but the breech moves only in conjunction with the body
-If the nurse-midwife feels the head, the fetus is in breech presentation; if the nurse-midwife feels the buttocks, it means the fetus is in vertex presentation
